Low-field standing magnetic resonance imaging findings of the metacarpo/metatarsophalangeal joint of racing Thoroughbreds with lameness localised to the region: a retrospective study of 131 horses

Reasons for performing study: The metacarpo/metatarsophalangeal (MCP/MTP) joint is a common site of lameness in the Thoroughbred racehorse. Radiographs may fail to show pathology consistent with the degree of lameness. With a high incidence of stress fractures occurring in the distal third metacarpal/metatarsal (MC3/MT3) condyles and proximal phalanx, a definitive diagnosis as to the nature of the pathology is essential. Objective: To describe the low‐field magnetic resonance imaging (MRI) findings in Thoroughbred racehorses with MCP/MTP joint pain scanned under standing sedation. Methods: The MR images and clinical records of all Thoroughbred racehorses undergoing MRI of the MCP/MTP joint between October 2006 and August 2010 were reviewed. A total of 168 joints from 131 horses were selected for inclusion. The MRI finding considered most significant in the lame (or lamest) limb was noted. Results: Diagnostic quality images were obtainable in 97.8% of horses. The most common finding was palmar/plantar osteochondral disease in MC3/MT3 (54.9% of horses). Incomplete condylar fracture was diagnosed in 19.8% of horses, with the lateral condyle predominating. An incomplete sagittal fracure of P1 was diagnosed in 14.5% of horses and 11.4% were diagnosed with ‘dorsal joint disease’. Other findings included transverse MC3 stress fractures (1.5%), soft tissue injuries (12.2%) and proximal phalangeal ‘contusions’ (3.8%). No significant bone/soft tissue injury was detected in 5.4% of cases. Conclusions: Standing MRI can detect a spectrum of disease within the MCP/MTP joints of racehorses. The procedure is well tolerated and may lead to a definitive diagnosis where radiographic imaging is inconclusive. Potential relevance: A total of 35.8% of cases had MRI findings consistent with fracture pathology, which could not be confirmed radiographically at the time of the MRI examination. This has important therapeutic and prognostic implications and may help to prevent catastrophic injury.     

Quantitative evaluation of subchondral bone injury of the plantaro‐lateral condyles of the third metatarsal bone in Thoroughbred horses identified using nuclear scintigraphy: 48 cases

Reasons for performing study: Increased radio‐isotope uptake (IRU) in the subchondral bone of the plantaro‐lateral condyle of the third metatarsus (MTIII) is a commonly reported scintigraphic finding and potential cause of lameness in UK Thoroughbred racehorses in training and has not been fully documented. Objectives: To characterise lameness attributable to IRU of the subchondral bone of MTIII, compare the scintigraphic findings of these horses with a normal population and evaluate the use of scintigraphy as an indicator of prognosis. Hypothesis: IRU will be in significantly higher in horses with subchondral bone injury and will be related to prognosis and future racing performance. Methods: Data were analysed from 48 horses in which subchondral bone injury of the plantaro‐lateral condyle of MTIII had been diagnosed using nuclear scintigraphy and that met the inclusion criteria. Data recorded included age, sex, trainer, racing discipline, lameness assessment, treatment regimes, radiographic and scintigraphic findings, response to diagnostic analgesia where performed and racing performance pre‐ and post diagnosis. Region of interest (ROI) counts were obtained for the plantar condyle and the mid diaphysis from the latero‐medial view, the ratio calculated and then compared with a control group of clinically unaffected horses. Results: The mean condyle mid‐diaphysis ROI ratio was significantly (P<0.001) higher in the affected population and with positively correlation (P = 0.024) with the level of lameness. The presence of radiographic findings had no significant effect on the ROI ratio. Conclusion: Subchondral bone injury of the plantar lateral condyles of MTIII is a significant cause of lameness in UK Thoroughbred racehorses. Nuclear scintigraphy is a useful diagnostic imaging modality in the detection of affected horses but is a poor indicator of prognosis for the condition. Potential relevance: Better understanding of the clinical manifestations, diagnosis of and prognosis for subchondral bone injury will benefit the Thoroughbred industry in the UK.     

Structural variation of the distal condyles of the third metacarpal and third metatarsal bones in the horse

This study examined 3-dimensional (3D) distribution of sectors with contrasting density in the equine third metacarpal (McIII) and third metatarsal (MtIII) bones with a view to explaining the aetiology of distal condylar fractures. Macroradiography and computed tomographic (CT) imaging were used in the nondestructive study of bones obtained from horses, most of which were Thoroughbreds in race training. Distal condylar regions of McIII and MtIII were also studied in microradiographs of 100 microm thick mediolateral sections cut perpendicular to the dorsal and palmar/plantar articular surfaces. Qualitative and quantitative results from all methods used (radiography, CT and microradiographic stereology) demonstrated a densification (sclerosis) of subchondral bone located in the palmar/plantar regions of the medial and lateral condyles of both McIII and MtIII. Substantial density gradients between the denser condyles and the subchondral bone of the sagittal groove were shown to equate with anatomical differences in loading intensity during locomotion. It is hypothesised that such differences in bone density results in stress concentration at the palmar/plantar aspect of the condylar grooves, which may predispose to fracture.     

Advanced imaging of an incomplete fracture and exostosis of the third metacarpal bone in a young Warmblood horse

A 5-year-old Hanoverian gelding with acute moderate right forelimb lameness underwent nuclear scintigraphy, which identified marked increase in radiopharmaceutical uptake of the proximomedial aspect of the right metacarpus. Ultrasonography and radiography identified sclerosis and exostosis of the proximomedial aspect of the metacarpal bone III in-between the suspensory ligament and the second metacarpal bone, and presence of a suspected fracture. The owner requested euthanasia of the gelding, and post-mortem computed tomography and magnetic resonance imaging identified marked bone sclerosis and thickening of the palmar cortex of the metacarpal III (McIII), presence of an incomplete fracture in the palmar cortex of McIII and expansive exostosis from McIII extending in a palmar direction between the suspensory ligament and the second metacarpal bone. Histopathological examination confirmed the imaging findings of sclerosis and led to final diagnosis of a fracture of the palmar cortex of the McIII associated with an exostosis encroaching the medial aspect of the suspensory ligament. No abnormalities were present in the suspensory ligament or metacarpal bone II (McII).     

Osseous cyst‐like lesions/subchondral bone cysts of the phalanges

In the horse, the phalanges are the second most common location for the occurrence of osseous cyst‐like lesions (OCLLs) after the medial femoral condyle of the stifle. Phalangeal OCLLs occur in a variety of locations, most of which are adjacent to, if not communicating with, a joint. The aetiology of these lesions is considered to be multifactorial by most authors. Horses with OCLLs demonstrate lameness of varying severity. Diagnostic analgesia should be used to localise the lameness. After localisation of the lameness, standard radiographic views of the isolated area should be performed. The radiographic characteristics of OCLLs are dependent on the stage of development of the OCLL; OCLLs may first be identified as a small lucent flattening or depression in the articular surface; however, they may progress to a circular, oval or conical single or multi chambered radiolucency within the bone. There may be a rim of radiodense sclerosis around the lucency. Diagnosis of some OCLLs may only be achieved using nonstandard radiographic views or may require advanced diagnostic imaging modalities such as computed tomography or magnetic resonance imaging. Treatment of phalangeal cysts may be conservative or surgical. Surgical treatment options generally aim to prevent cyst enlargement and promote filling of the lesion with osseous material. Depending on the cyst, this can be performed arthroscopically or via an extra‐articular approach. Occasionally, the severity of proximal interphalangeal joint OCLLs warrants surgical arthrodesis. Overall the prognosis for return to performance for horses with OCLLs ranges from 30–90% but is dependent on the breed, age and intended use of the horse, surface area of weightbearing cartilage affected, concurrent osteoarthritis within the joint and treatment administered.     

Long incomplete longitudinal fractures of the third metacarpal and metatarsal bone in horses

Five horses with long incomplete longitudinal fractures of the third metacarpal bone and three horses with similar fractures of the third metatarsal bone were examined. In three of the metacarpal fractures a long incomplete fissure extended proximomedially, in association with the more common lateral condylar fracture of the third metacarpal bone, and in the other two cases the fracture originated from the medial aspect of the distal articular surface. In the three horses with fractures of the third metatarsal bone the fractures had a consistent spiral configuration.     

Radiographic and scintigraphic evaluation of the third carpal bone of control horses and horses with carpal lameness

We compared the radiographic and scintigraphic findings in the third carpal bone of horses performing different work disciplines and investigated their relationship with lameness. Horses had undergone carpal radiography including acquisition of a dorsoproximal-dorsodistal oblique (DPr-DDiO) image of the distal row of carpal bones and/or scintigraphic examination of the carpi. Cause of lameness, breed, age, and work discipline were recorded. Increased opacity in the third carpal bone was graded, ratio of radiopharmaceutical uptake calculated objectively, and increased radiopharmaceutical uptake graded subjectively. Relationships between radiographic, scintigraphic, and clinical findings were assessed statistically. Increased opacity in the third carpal bone (P = 0.003) and ratio of radiopharmaceutical uptake (P = 0.015) were associated with the work discipline. Increased opacity in the third carpal bone was associated with both increased radiopharmaceutical uptake grade (P = 0.002; rs = 0.59) and ratio of radiopharmaceutical uptake (P = 0.013; rs = 0.46). Increased radiopharmaceutical uptake and increased opacity in the third carpal bone were not always observed concurrently. Lameness related to the middle carpal joint was associated with increased opacity (P < 0.001), ratio of radiopharmaceutical uptake (P = 0.037), and increased radiopharmaceutical uptake grade (P < 0.001). Radiographic and scintigraphic abnormalities were observed in horses performing all disciplines, indicating that high-speed exercise may not be the only factor determining the development of osseous disease in the third carpal bone. Both increased opacity and increased radiopharmaceutical uptake were more likely to be seen in horses with lameness related to the middle carpal joint than in horses with other sources of pain.     

Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 8. Quantitative back-scattered electron scanning electron microscopy and confocal fluorescence microscopy of the epiphysis of the third metacarpal bone

AIM: To characterise and explain the increase in density evident by computerised tomography (CT) and radiography in companion studies as a response to training, in bone in the palmar and dorsal regions of the condyles of the third metacarpal bone (Mc3) of 2-year-old Thoroughbred horses.

METHODS: Compositional back-scattered electron (BSE) imaging in scanning electron microscopy (SEM) and confocal scanning laser microscopy (CSLM) were conducted on polymethyl methacrylate (PMMA)-embedded mediolateral slices of the right distal Mc3 from seven 2-year-old Thoroughbred horses trained on a racetrack and seven untrained horses kept at pasture. One left Mc3 from each group was studied in transverse section planes. This study focussed on regions of Mc3 found to differ in density between the trained and untrained horses in companion studies using CT and radiography.

RESULTS: The increase of bone density in the condyles of Mc3 in trained horses compared with untrained horses occurred, without prior osteoclastic resorption, via the deposition of new bone on pre-existing internal surfaces. Within prior marrow spaces of cancellous bone, there was also rapid formation of immature strands and fronds of bone which were more cellular and mineralised, and more lamellar bone tissue was deposited on these new scaffolding elements in the trained horses. Both resulted in increased bone volume fraction (BVF). The microscopic mineralisation density of the bulk of the new tissue was lower than in pre-existing bone, and CT and radiography underestimated the increase in BVF. The new tissue was thus probably less stiff at the microscopic scale than pre-existing bone, though its addition would stiffen the global structure.

CONCLUSIONS: In Mc3 of all the trained horses, there were obvious differences in microscopic structure compared with those from the untrained horses. Moderate, industry-standard levels of exercise used to prepare young horses for racing induced the formation of new bone in non-bone spaces in bone tissue, such that the bone organ should better withstand later increased levels of exercise.     

Effects of exercise on chondrocyte viability and subchondral bone sclerosis in the distal third metacarpal and metatarsal bones of young horses

The objective was to determine the effects of early exercise on the articular cartilage and subchondral bone at specific sites of the distal third metacarpal and metatarsal bones of 12 young Thoroughbred horses allowed free choice exercise at pasture. Six of the horses had additional controlled exercise 5 days per week from mean age of 21+/-20 days of age (range: 3-83 days) until 17.1 months of age. Confocal laser scanning microscopy was used to quantify viable and non-viable chondrocytes. Proteoglycan scoring and modified Mankin scoring was performed and subchondral bone mineral density measured by computed tomography. The number of viable chondrocytes was significantly greater in the conditioned group, which also had a higher Safranin O/Fast Green (SOFG) score than did the group which could exercise only at pasture. There was no difference in mean bone mineral density between groups, nor was there relationship between subchondral bone mineral density and chondrocyte viability. The apparent beneficial effects of early conditioning exercise may support the use of exercise to optimise development of articular cartilage in young individuals.     

Arthroscopic visualisation of the third metacarpal and metatarsal condyles in the horse

Reasons for performing study: Arthroscopy of the fetlock joints is a routine surgical procedure in the horse. It is unclear how much of the articular surface of the condyles of the metacarpal (MCIII)/metatarsal (MTIII) bone can be visualised using either the dorsal or palmar/plantar arthroscopic approach. Objectives: To investigate which part of the articular surface of the MCIII/MTIII condyles of the fetlock joints can be evaluated arthroscopically using: 1) dorsal approach in combination with flexion; 2) standard palmar/plantar approach; or 3) additional portal at the base of the sesamoid bone with joint extension. Methods: All 3 arthroscopic approaches were performed on 20 fore‐ and 20 hindlimbs of 14 cadavers. For each approach, a curette was inserted ipsilaterally to create a lesion at the most distal part of the condyle that could be seen. After disarticulation and placement of a nail in each lesion, the maximally reachable angle was calculated on a perfect lateromedial radiograph. The 0° angle was determined as the distal crossing of the best fitting circle around the condyle with a line parallel to the dorsal MCIII/MTIII bone running through the circle centre (positive angle dorsal to 0°, negative palmar/plantar to 0°). Results: Using the dorsal approach with flexion, a significantly larger area of visualisation was present in the hind‐ (?23.4°) compared to the forelimb (+2.7°). Using the palmar/plantar approach (fore: ?60.4°; hind: ?70.7°) and the approach at the base of the sesamoid bone (fore: ?36.3°; hind: ?47.6°) more cartilage could be seen in the fore‐ compared to the hindlimb. When combining the 3 approaches, the remaining nonvisible part measured 38.9° in the fore‐ and 24.2° in the hindlimb, both located palmaro/plantarodistally. Conclusions: The use of dorsal and palmar/plantar arthroscopic approaches in combination with flexion and extension of the fetlock joint allows visualisation of the majority of the cartilage of the MCIII/MTIII condyles. The nonvisible section is smaller in the hindlimb compared to the forelimb. Potential relevance: Knowledge of the specific areas of visualisation of the condyles on arthroscopy is important for both diagnostic and therapeutic planning of fetlock disorders.     

Magnetic resonance imaging of bone marrow in the pelvis and femur of young dogs

The purpose of this study was to determine the magnetic resonance (MR) imaging characteristics of bone marrow in the pelvis and femur of normal, young dogs. Six greyhounds were imaged at 4, 8, 12, and 16 months of age. Sagittal images of the femur and dorsal images of the pelvis were obtained with T1-weighted, fast spin echo (FSE) T2-weighted, and short tau (T1) inversion recovery (STIR) sequences. On T1-weighted images areas with high signal intensity, similar to fat, included the femoral heads, mid-diaphysis of the femur, femoral condyles, and the body of the ilium. T2-weighted images were characterized by uniform intermediate signal intensity (less than fat, but greater than muscle) in the femoral head, high signal intensity, similar to fat, in the mid-diaphysis of the femur and ilial body, and intermediate to high signal intensity in the femoral condyle. By 16 months high signal intensity was seen in the diaphysis and distal metaphysis on both T1- and T2-weighted images. On STIR images the femoral head had intermediate to low signal intensity, compared with muscle. The mid-diaphysis of the femur was of low signal intensity, similar to fat, and the body of the ilium had mixed signal intensity at all ages. The femoral condyle had inhomogenous, intermediate to low signal intensity at 4 months, but was of uniform low signal intensity at 8-16 months.     

Changes in mineralised tissue at the site of origin of condylar fracture are present before athletic training in Thoroughbred horses

Abstract

AIM: To show that changes are present at the site of origin of metacarpal condylar fracture in young Thoroughbred horses before they enter race training.

METHOD: Bone slices, 2 mm thick, in three mediolateral planes through the centre of rotation of the metacarpo-phalangeal joint (MCPJ) of both distal third metacarpal bones (Mc3) of 12 Thoroughbred horses aged 17 months, were imaged using point-projection digital X-ray imaging (µXR).

RESULTS: In some horses, linear or ovoid radiolucency was found in articular calcified cartilage (ACC) and subchondral bone of the palmaro-distal aspect of the sagittal groove, exactly at the site of more advanced stages of condylar fatigue fracture. An incidental finding was ovoid radiolucency in the apex of the dorso-distal aspect of the sagittal ridge, with or without fragmentation or disturbance of the subchondral mineralised tissue line, resembling equine osteochondrosis.

CONCLUSIONS AND CLINICAL RELEVANCE: The findings imply that the aetiology of condylar fatigue fracture in young Thoroughbred horses includes abnormality in development of the bone and joint that is present before athletic activity occurs.     

Standing MRI lesions of the distal interphalangeal joint and podotrochlear apparatus occur with a high frequency in warmblood horses

Foot pain is a common presenting complaint in Warmblood horses. The aim of this retrospective, cross‐sectional study was to determine the spectrum of foot lesions detected by magnetic resonance imaging (MRI) in Warmblood horses used for dressage, jumping, and eventing. The medical records of 550 Warmblood horses with foot pain that were scanned using standing MRI were reviewed and the following data were recorded: signalment, occupation, lameness, diagnostic analgesia, imaging results, treatments, and follow‐up assessments. Associations between standing MRI lesions and chronic lameness following treatment were tested. Abnormalities of the navicular bone (409 horses, 74%), distal interphalangeal joint (362 horses, 65%), and deep digital flexor (DDF) tendon (260 horses, 47%) occurred with the highest frequency. The following abnormalities were significantly associated (P < .05) with chronic lameness following conservative therapy: moderate to severe MRI lesions in the trabecular bone of the navicular bone, mild or severe erosions of the flexor surface of the navicular bone, moderate sagittal/parasagittal DDF tendinopathies, and moderate collateral sesamoidean desmopathies. Also, identification of concurrent lesions of the DDF tendon, navicular bone, navicular bursa, and distal sesamoidean impar ligament was associated with chronic lameness after conservative therapy. Development of effective treatment options for foot lesions that respond poorly to conservative therapy is necessary.     

Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 6. Bone parameters in the third metacarpal and third metatarsal bones

AIM: To determine the effect of a known training regimen on the size and mineral content of the third metacarpal (Mc3) and third metatarsal (Mt3) bones of 2-year-old Thoroughbred horses trained on racetracks.

METHODS: Mc3 and Mt3 of seven horses trained on grass and sand tracks were scanned at several sites using conventional quantitative and peripheral computed tomography (CT). Bone dimensions and density in the diaphysis and epiphysis were compared with those from seven untrained horses. Calcein label was injected in two clusters, during Weeks 9 and 12. The extent and rate of diaphyseal modelling was determined by confocal fl uorescent microscopic examination of thin plane parallel sections of the mid-metacarpal region.

RESULTS: Volumetric bone mineral density (BMDv) of the epiphysis was markedly higher and of the diaphysis was slightly higher in trained compared with untrained horses, but greater bone size in the trained horses had the greatest effect on an index of bone strength. Active osteons, defined as Haversian systems containing calcein label, were fewer, of smaller diameter at the time of calcein injection, and had a greater bone apposition rate in trained than in untrained horses.

CONCLUSIONS: Conventional training of 2-year-old Thoroughbred racehorses over a 13-week period had a significant effect on bone size, density and strength index when compared to untrained horses.

CLINICAL RELEVANCE: Bone responded rapidly to early training. The data provide reference values and sites for use in longitudinal studies of commercial training regimens.     

Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 6. Bone parameters in the third metacarpal and third metatarsal bones

AIM: To determine the effect of a known training regimen on the size and mineral content of the third metacarpal (Mc3) and third metatarsal (Mt3) bones of 2-year-old Thoroughbred horses trained on racetracks. METHODS: Mc3 and Mt3 of seven horses trained on grass and sand tracks were scanned at several sites using conventional quantitative and peripheral computed tomography (CT). Bone dimensions and density in the diaphysis and epiphysis were compared with those from seven untrained horses. Calcein label was injected in two clusters, during Weeks 9 and 12. The extent and rate of diaphyseal modelling was determined by confocal fluorescent microscopic examination of thin plane parallel sections of the mid-metacarpal region. RESULTS: Volumetric bone mineral density (BMDv) of the epiphysis was markedly higher and of the diaphysis was slightly higher in trained compared with untrained horses, but greater bone size in the trained horses had the greatest effect on an index of bone strength. Active osteons, defined as Haversian systems containing calcein label, were fewer, of smaller diameter at the time of calcein injection, and had a greater bone apposition rate in trained than in untrained horses. CONCLUSIONS: Conventional training of 2-year-old Thoroughbred racehorses over a 13-week period had a significant effect on bone size, density and strength index when compared to untrained horses. CLINICAL RELEVANCE: Bone responded rapidly to early training. The data provide reference values and sites for use in longitudinal studies of commercial training regimens.     

Comparison between magnetic resonance imaging and histological findings in the navicular bone of horses with foot pain

Reasons for performing study: There is limited knowledge about both histological features in early navicular disease and what histological features are represented by increased signal intensity in fat‐suppressed magnetic resonance (MR) images of the navicular bone. Objective: To characterise increased signal intensity in the spongiosa of the navicular bone in fat‐suppressed MR images and to compare this with histopathology; and to compare objective grading of all aspects of the navicular bone on MR images with histological findings. Methods: One or both front feet of 22 horses with foot pain and a median lameness duration of 3 months were examined using high‐field MR imaging (MRI) and histopathology. The dorsal, palmar, proximal and distal borders of the navicular bone and the spongiosa were assigned an MRI grade (0–3) and a histological grade and compared statistically. Results: Increased signal intensity in the spongiosa of the navicular bone was associated with a variety of abnormalities, including fat atrophy, with lipocytes showing loss of definition of cytoplasmic borders, a proliferation of capillaries within the altered marrow fat, perivascular or interstitial oedema, enlarged intertrabecular bone spaces, fibroplasia and thinned trabeculae showing loss of bone with irregularly spiculated edges of moth‐eaten appearance. There were significant associations among histological lesions of the fibrocartilage, calcified cartilage and subchondral bone. There were also significant associations between MRI grading of the spongiosa and both histological marrow fat grade and the combined maximum of the MRI grades for the fibrocartilage. Conclusions and potential relevance: Increased signal intensity in the spongiosa of the navicular bone in fat‐suppressed MR images may occur in association with lesions of the fibrocartilage with or without subchondral bone or may represent a separate disease entity, particularly if diffuse, reflecting a variety of alterations of trabecular bone and marrow fat architecture.